Papillary Response In Contact Lens Papillary Conjunctivitis
Is Either General Or Localised
Sankaridurg P 1 , Sweeney D 1 , Naduvilath T 2 , Aasuri M, Holden B 1 , Rao GN 2
Cornea and Contact Lens Research Unit at the School of Optometry and the Cooperative Research Centre for Eye Research and Technology, Sydney, Australia 1 ; L.V.Prasad Eye Institute, Hyderabad, India 2
DISCUSSION
RESULTS
PURPOSE
Contact Lens Papillary Conjunctivitis (CLPC), is of significance
as it is a major cause for patients discontinuing from contact
lens (CL) wear.1 However, the aetiology of the condition is
poorly understood. We determined if during CLPC, specific
areas of the tarsal conjunctiva exhibit a papillary response.
This may help provide some insights into the mechanisms
leading to the condition.
Sixty eight (68) events of CLPC were
observed in 51 subjects. Of these, 64
were first events. Following the first
event, 23 subjects were continued in lens
wear and there were 4 recurrent events.
Age (yrs)
21± 2.7 (16-28)
Sex (M:F)
40 (78%): 11 (22%)
CL power (D)
Lens type
-3.30 ± 1.30 (-1.00 to -6.00)
76.5%
23.5%
Low Dk
High Dk
Duration in lens wear (mnths)
METHODS
t
9.5 ± 6.3 (1-25)
Clinical presentation of CLPC events (First events only)
t
t
t
Prospective CL clinical trials at L.V.Prasad Eye Institute,
Hyderabad, India from March 1993 to September 2000.
1,584 eyes of 792 subjects. Low Dk disposable CL (FDA
Groups Type I, II & IV) on a 6 night (N) extended wear and
disposal schedule or high Dk silicone hydrogel CL on a 30N
extended wear and disposal schedule.
Events of CLPC diagnosed were considered for the study.
Upper tarsal conjunctival examination:
t The upper tarsal surface was classified into 5 areas and:
4
31%
69%
3
2
t
Local
1
General
General
Area1
Mean roughness(0-4)
3
BL
3
At event
*
*
2
4
1
4
1
Area1
Area1
Area2
Area2
Area3
Area4
Area3
Area5
Area4
3
Area5
2
Roughness at baseline compared to at event
1
Local
3
2
1
- roughness (0-4 where 0= no roughness and 4= severe)
was recorded in each area. Tarsal roughness at baseline
(BL) was compared to CLPC using Grouped T-test.
Mean roughness(0-4)
4
At event
1.
2.
3.
4.
5.
4
3
3
*
*
2
2
4
1
1
3
Area1
Area2
Area3
Area4
Area1
Area2
Area4
Roughness
at
baseline Area3
compared to
at
1=very slight
2=slight
3=moderate
Area2
Area3
3
REFERENCES
Area1
Area2
Area3
BL
No
Area4
Area5
Area1presentations
Area2
Area3
Area4 and local
Area5
Two distinct
of CLPC,
general
were observed and may indicate different mechanisms
underlying the response. The prevalence of general was
greater then the local response. Possible risk factors
include the lens type, however, these differences were
not addressed in this study. The type and nature of the
cellular infiltration of the tarsal conjunctival epithelium
in these 2 categories may provide further insights to the
mechanisms
leading to these conditions.
4
Area1
Yes
Area3
CONCLUSION
*
*
2
Area2
1
4
4
- the presence of papillae in each area recorded as yes/no.
If papillae present, and scattered across the tarsus, it was
‘General’ and if located in specific areas, it was ‘Local’.
t
Papillae
in
‘General’
were
found
all
over
central tarsus (Areas 1, 2 & 3) and in Area 5.
However, in ‘Local’, the papillae were primarily
in Areas 2 & 3. Interestingly, Korb et al reported papillae
with hard CL wear to be present mainly in the zone
adjacent to lid margin and the intervening central
zone. 2 In contrast, papillae with soft CL wear were
found mainly in the zone adjacent to tarsal fold and
never
adjacent to lid margin. 3 Localised papillae
were also reported in response to sutures, elevated
corneal deposits etc. 4,5
The association of localised papillae with rigid CL
w e a r, s u t u r e s , e l e v a t e d c o r n e a l d e p o s i t s e t c
suggests that mechanical trauma could be
responsible. It is probable that
the physical
4
interaction
of the CL surface or edge with the
conjunctival surface could lead to local papillae .
The
risk factors leading to
‘General’ response are
3
not clear and it is possible that mechanical factors
or
2 other factors such as deposits leading to an
immune reaction are responsible.
Area5
eventArea5
4=severe
*>1 grade roughness.
Roughness was slight at BL in all areas and was significant at event for all areas for both categories (p < 0.05).
2
Area4
Area4
Area5
Area5
Sankaridurg
PR, Sweeney DF, Sharma S et al: Ophthalmol, 106(9), 1671-1680, 1999.
2
Korb DR, Allansmith MR, Greiner JV et al: Ophthalmol, 88(11), 1132-1136, 1981.
Korb DR, Greiner JV, Finnemore VM et al: Br J Ophthalmol, 67(11), 733-736, 1983.
Sugar A, Meyer R: Am J Ophthalmol, 91, 239-242, 1981.
1
Dunn
BJ, Weissman B, Mondino B: Cornea, 9, 357-358, 1990.
ACKNOWLEDGEMENTS
Area1
Area2
Area3
Area4
Area5
The study was funded in part by the Australian Federal Government through
the CRC scheme, Hyderabad Eye Research Foundation, Vistakon, USA and
Bausch & Lomb, USA . The authors would like to thank I-Media Graphics for
their assistance in preparation of this poster.
1
Area1
Area2
Area3
Area4
Area5